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PEi�MIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS f� FARCEL TA7(I.D.N PERMI7 K <br /> C �/ � Co �C -G <br /> LEGA LOTNO. BLOCK TRAC7 <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> c 11�'r �J/l .�? r��l I � ��/'� ✓y�i�"��� Q�o�1 �la�dra -C�7� <br /> TENANTNAME I CONTACTNAME PHONE <br /> CONTRACTOR AODRESS ZIP CONTR.UCENSE M <br /> PHONE <br /> PROPOSED USE OF BUILDING Building f'1 Mechanical Addition HEAT SOURCE <br /> PERMIT B Combinatian F_� Plumbing WORK R Alteralion n Electric <br /> TVPE D Demolilion �, Sign TYPE D New ❑ cas <br /> U Sprinkler � qepaidMaint. D Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TA%COOE IS 3105 <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURt JR REM NO. TYPE Of FlXTURE OR ITEM <br /> WATER CLOSET A/C—A/HANDLING UNITS <br /> BATHTUB FOR(:ED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWEN UNIT HEATERS <br /> _L K�TCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> / DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN OAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEREBY CERITIFY THAT�HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF L4W5 AND OR�DINACES GOVERNING TH�S TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORI7Y TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE PEFFORMANCE OF CONSTiiUCTION. THAT I AM AUTHORIZED BY THE <br /> ' OWNER OF THIS PROPERTY TO PERPORM THE WORK POR WHICH APPIICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> CON CTORS W 18. RC AND 29 200 WAC. <br /> � ^ / � <br /> . � � <br /> nature ol wner/Contractor/Authorized Agent Date <br />